Cervico-shoulder dystonia following lateral medullary infarction: a case report and review of the literature

Abstract

BackgroundSecondary cervical dystonia is induced by organic brain lesions involving the basal ganglia, thalamus, cerebellum, and brain stem. It is extremely rare to see cervical dystonia induced by a medullary lesion.Case presentationWe report a case of an 86-year-old Japanese woman who developed cervical dystonia following lateral medullary infarction. She developed sudden-onset left upper and lower extremity weakness, right-side numbness, and dysarthria. Brain magnetic resonance imaging revealed an acute ischemic lesion involving the left lateral and dorsal medullae. A few days after her stroke, she complained of a taut sensation in her left neck and body, and cervico-shoulder dystonia toward the contralateral side subsequently appeared. Within a few weeks, it disappeared spontaneously, but her hemiplegia remained residual.ConclusionsTo date, to the best of our knowledge, there has been only one reported case of cervical dystonia associated with a single medullary lesion. It is interesting to note the similarities in the clinical characteristics of the previously reported case and our patient: the involvement of the dorsal and caudal parts of the medullary and associated ipsilateral hemiplegia. The present case may support the speculation that the lateral and caudal regions of the medulla may be the anatomical sites responsible for inducing cervical dystonia.

Brainstem Reflexes in Idiopathic Cervical Dystonia: Does Medullary Dysfunction Play a Role?

“…pathways mediating the BR and the TCR reside [51][52][53] . There is controversy about the presence of central nervous system damage in idiopathic dystonias.…”

Dystonia as a Presenting Feature of Acute Ischemic Stroke: A Case Report and Literature Review

“…Although unexpected, there were cases of acute dystonia presenting as ischemic strokes involving brainstem structures. Of the five cases, two had strokes in the midbrain [9,10], and one each had strokes in the pons [11], medulla [12], and cerebellum [13]. Of particular interest was a 56-year-old male who was noted to have dystonic posturing on his left wrist four days after initial presentation with left-sided weakness and dysarthria.…”

Cervical Dystonia Mimics: A Case Series and Review of the Literature

“…2–5 However, vascular anomalies are noted to have abnormal neck posturing due to compensatory mechanisms to aid visual defects. 6 Other vascular causes like aneurysms and arteriovenous malformations (AVM) can also result in dystonia.…”